- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.90 / $37.15 / $44.67
| Facility | | $30.90 | $37.15 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.99 / $36.31 / $74.13
| Professional | | $23.99 | $36.31 | $74.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.12 / $28.18 / $44.67
| Professional | | $25.12 | $28.18 | $44.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $77.62 / $87.10
| Professional | | $60.26 | $77.62 | $87.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.74 / $44.67 / $56.23
| Professional | | $40.74 | $44.67 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.38 / $44.67 / $67.61
| Professional | | $17.38 | $44.67 | $67.61 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.15 / $64.57 / $91.20
| Professional | | $37.15 | $64.57 | $91.20 |